Initial Clinical Experience with a Holmium:Yag Laser

Abstract

Transmyocardial laser revascularization (TMLR) has been used in many patients to effectively treat angina that is refractory to medical therapy and which cannot be treated by traditional revascularization techniques. To date, a majority of these procedures have been performed with a carbon dioxide laser. However, because of the potentially large number of patients who could benefit from such a therapy, either as sole therapy or as an adjunct to coronary bypass and angioplasty, several different types of laser energy sources have been developed for TMLR. At least two clinical trials are currently underway investigating the safety and efficacy of holmium: YAG lasers. Our institution has been participating in an international, multicenter study evaluating one such laser; the CardioGenesis ITMR System. As part of this study, fifteen patients have so far undergone TMLR as sole therapy in the United States with the CardioGenesis ITMR System and, as reported in other trials, there has been an immediate and clinically significant reduction in angina observed in most patients [1]. In this chapter, we summarize the rather dramatic results obtained in our first patient in this trial.